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Lay 111 call handlers could be allowed to use their own judgement, says Hunt

The health secretary has said non-medically trained 111 call handlers could be allowed to use more of their personal judgement when speaking to patients, in a move attacked by GP leaders.

In the closing speech at the 2014 Health and Care Innovation Expo on Tuesday, Jeremy Hunt also said that call handlers could be allowed to access patient records, with the patient’s consent, so they ‘know more about the person they’re speaking to’.

However, GP leaders said these plans would lead to 111 providers missing serious patient issues, and the health secretary was in ‘cloud cuckoo land’ if he thought handlers should use their personal judgement.

Under the NHS 111 triage system, patients speak to non-medically trained call handlers, who ask them a series of questions based on computer algorithms.

Answering a question from a call handler, Mr Hunt said he felt the triage process could be simplified.

He said: ‘I think we can do a great deal more to support you by, as I mentioned earlier, by allowing – with patient’s permission – 111 operators to access medical records so that you know more about the person you’re speaking to.’

‘I’ve always wondered whether we could do work on the algorithm that you have to use to make it shorter, and simpler, and allow 111 operators to use more of their judgement.’

The urgent care service, introduced in March 2013, had a troubled start, with some out-of-hours services having to step in to take back triage services.

It had been criticised by GP leaders for using non-medically trained call handlers as the first point of call for patient, and a Pulse survey at the time found just 8% of GPs believed it provided appropriate triage.

Dr Peter Holden, GPC lead on urgent and emergency care and a GP in Derbyshire, rubbished the health secretary’s suggestion.

He said: ‘[Call handlers] can’t do the judgement, they haven’t got the skills, or the knowledge or the expertise. They’re not healthcare professionals, they’re not in a position to use judgement, not in that sense of the word, and if he thinks it’s that easy, he’s in cloud cuckoo land.’

Dr Holden explained that, while a trained clinician could make diagnoses rapidly through hypothesis testing, call handlers had to rely on ‘pattern recognition’ through the series of questions in the NHS 111 algorithm.

He told Pulse: ‘There is a certain, minimum time it takes you to ask 111 questions and get the answers, and make the computer read it. And that’s what slows it up.’

‘And so if he simplifies it, he will miss serious stuff.’

A Department of Health spokesperson said: ‘NHS 111 has become a core part of the urgent care service, offering expert advice to patients when they’re most in need.’

‘Our aim is that if you are calling 111, you will quickly be able to talk to a professional who will have the relevant information from your summary care record in front of them. NHS England is currently working on making this happen.’